Provider Demographics
NPI:1699023945
Name:CALDERON, SURAYA C
Entity Type:Individual
Prefix:
First Name:SURAYA
Middle Name:C
Last Name:CALDERON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:160 E VIRGINIA ST STE 280
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95112-5817
Mailing Address - Country:US
Mailing Address - Phone:408-938-2113
Mailing Address - Fax:408-579-6143
Practice Address - Street 1:160 E VIRGINIA ST STE 280
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95112-5817
Practice Address - Country:US
Practice Address - Phone:408-938-2113
Practice Address - Fax:408-579-6143
Is Sole Proprietor?:No
Enumeration Date:2012-08-16
Last Update Date:2023-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA109636106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist